A Christian framework for medical ethical decision-making

How should Christians make ethical decisions? Should we use secular decision-making systems that are deontological (rule-based) or consequentialist (outcome based)? Or can we derive an ethical framework from the Bible?

Christians are called to imitate God (Ephesians 5:2), imitate Christ (1 Corinthians 11:1) and to walk as Christ walked (1 John 2:6). We are to be holy because God himself is holy (Leviticus 19:2; I Peter 1:16).

We might say that this is impossible but we forget three things – that through Jesus death and resurrection God has granted us repentance (Acts 5:31), given us a new nature (2 Corinthians 5:17) and placed the Holy Spirit within in us to empower us to live lives which are pleasing to him (Romans 8:9-11). This is why it is possible for us both to ‘put off’ ungodly thoughts and actions and to ‘put on’ godly attitudes and behaviours (Ephesians 4:22-24).

So how are we then to make Christ-like ethical decisions? I would suggest that doing so involves four elements: sharing the mind of Christ, holding the commands of Christ, showing the character of Christ and carrying the cross of Christ.

Let’s consider each of those in turn.

Sharing the mind of Christ

To share the mind of Christ, we first need to have a Christian worldview. We need to think about the world in the way that Jesus does and in the way the Bible teaches; in terms of creation, fall, redemption and future hope.

We are created by God in his image for an eternal relationship with him. But we have also, individually and collectively, fallen from grace. We are sinful and this sin has every aspect of our beings; our bodies, our emotions, our relationships, and our moral decision making. We are masterpieces created by the grand master, but we are flawed masterpieces in need of redemption.

God has initiated his great plan of redemption through his dealings with Israel and ultimately through the sending of his Son Jesus Christ, through whose death and resurrection we can be reconciled to God through repentance and faith.

We now have a hope that is certain, guaranteed by God himself, that we can have confidence for the day of judgment because of what Jesus has done for us, and will live together with God and fellow believers forever in God’s presence in a new heaven and new earth.

Sharing the mind of Christ involves having that linear view of history and that confidence about the future. 

Holding the commands of Christ

Holding the commands of Christ means being guided by his word in the way we make ethical decisions. Jesus said that if we love him we will obey his comands (John 14:15, 15:14). But what are his commands?

What starts in the Old Testament as the Old Covenant, the Ten Commandments and the 613 laws of the Pentateuch is, of course, a shadow prophetically pointing to the person of Christ, who will be the only one who is able to fulfil them (Colossian 2:17; Hebrews 10:1).

In the New Testament, specifically in the Sermon on the Mount (Matthew 5-7), we see Christ going beyond the mere external legalities of Old Testament law to the very spirit of love that underlies it. 

He says (Matthew 22:37-40) that the most important commands in the law are to love God with all one’s heart, soul, mind and strength (Deuteronomy 6:5) and to love one’s neighbour as oneself (Leviticus 19:18).

Jesus also gave his disciples a new commandment, to love one another as he had loved them (John 13:34,35).

But we are told that all Scripture is inspired (literally breathed) by God and profitable for teaching, correction, reproof and training in righteousness (2 Timothy 3:16,17). So, we need to work hard at deducing biblical ethical principles to apply to today’s ethical dilemmas.

Here are some key biblical principles:

Stewardship: we are given skills and abilities, not in order to exploit the earth, but to be its vanguards and its stewards, caring for the earth and for each other in the same way that God would care (Genesis 1:26). We are God’s delegated vice-rulers. This obviously applies to the scientific knowledge and technology that he has given to us. In fact, we see the beginnings of science, in Adam naming the animals (taxonomy) (Genesis 2:19,20) and technology with Jubal and Tubal-Cain developing musical instruments and metal tools (Genesis 4:21,22).

The sanctity of life: every human being is precious in God’s sight because every human being is made in the image of God (Genesis 1:27). It is because of this that human beings cannot be unjustly killed (Exodus 20:13; Deuteronomy 5:17). God will hold us accountable for the shedding of innocent blood (Genesis 9:5,6).

Chastity: sexual faithfulness. As we learn, ultimately, in the New Testament, the pattern of ‘one man, one woman, for life’ (Genesis 2:24) is a beautiful picture or metaphor of Christ’s marriage with the Church (Ephesians 5:31,32) and points, eschatologically, to the New Jerusalem, and the new Heaven and the new Earth (Revelation 22:17).

Veracity: the telling of truth (Exodus 20:16; Leviticus 19:11; Deuteronomy 5:20), because God is truthful and tells no lies (Numbers 23:19; Titus 1:2).

Justice: both at an individual and corporate level, so that vulnerable people are protected from exploitation. So much of the Old Testament law, of course, is about guarding the weak (Proverbs 31:8,9).

Grace: giving people what they don’t deserve (Matthew 5:43-48).

Mercy: not giving people what they do deserve, so that we are called to share the mind of Christ, both from a worldview and ethics (Micah 6:8).

Having the mind of Christ and keeping the commands of Christ are crucial, but we are also called to show the character of Christ because Christian ethics is not just about what we do, but also about how we do it. 

Showing the character of Christ

This brings us back to Plato’s idea that in order to act virtuously, one has to be a virtuous person. One can only act virtuously, in a Christian sense, by being born again, and then transformed by the Holy Spirit so that one develops the fruit of the Holy Spirit: love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, self-control (Galatians 5:22,23).

It is one thing to know the right thing to do. It is something else altogether to have the character to do it.

Standing firm in making correct ethical decisions requires great wisdom, patience, perseverance and courage.

Carrying the cross of Christ

Carrying Christ’s cross means two things in a world hostile to Christian faith and values. It means, first of all, that we are prepared to fulfil the ‘Law of Christ’.

The Law of Christ is an interesting concept. It is mentioned twice in the New Testament. The first mention comes in 1 Corinthians, where Paul says, ‘I am not under the law, but I am under Christ’s law’ (1 Corinthians 9:21). Then, in Galatians, we have the command: ‘Bear one another’s burdens and so fulfil the law of Christ’ (Galatians 6:2).

This lines up with Christ’s words to his disciples at the Last Supper: ‘A new commandment I give to you: love one another as I have loved you’ (John 13:34,35).

If you like, it is the very opposite of the Darwinist ethic of the weak being sacrificed for the strong. It is instead the strong making sacrifices for, or laying down their lives for, the weak.

This is the guiding ethic for everything we see in the New Testament. For example, with the ethics of giving: ‘Christ, who was rich, became poor so that you might be rich’ (2 Corinthians 8:9). Why? In order that we ourselves might then become poor so that we can make others rich. We are called to emulate Christ in making sacrifices, or laying down our lives, for the weak (Romans 5:8).

Additionally, part of carrying the cross in a society hostile to Christian faith and values is that we are prepared to speak and act in godly ways, even when it is tremendously costly to do so; in other words, even when it leads to great opposition. This is part of the cross.

Christ bore the burdens of others and carried out great acts of compassion of healing and love. But he wasn’t crucified for these acts of compassion. It was actually his words that led to his death (John 7:7). It was when he spoke unpalatable truth about his own identity (John 5:18) and when he spoke prophetically about the nation in which he was placed (Matthew 26:63-68). That was when persecution really came to bear.

As Christ’s people living in this age we are called to carry the cross of Christ (Matthew 16:24; Luke 9:23, 14:27). That involves both sacrificial service and also faithfully speaking the truth, regardless of the cost, whether it is preaching the Gospel or speaking moral truth in the public sphere.

So there we have it – we can be imitators of Christ by having his mind, holding his commands, showing his character and carrying his cross.